Parathyroid function and serum calcitonin in children receiving anticonvulsant drugs

Kruse, K.; Bartels, H.; Ziegler, Reinhard; Dreller, E; Kracht, Ute

doi:10.1007/bf00441584

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…Kruse et al [18] found low serum iCT levels in epileptic children receiving anticonvulsants. A similar observation was made for the walking patients in the present study (group 3), their serum iCT levels being slightly lower than those of the patients without therapy, although the difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 98%

Decreased bone density in severely handicapped children and adults, with reference to the influence of limited mobility and anticonvulsant medication

1986

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Bone density and related biochemical parameters were investigated in institutionalised children and adults with severe handicaps, who were classified according to the degree of limited mobility (group 1, bed-ridden; group 2, capable of crawling; group 3, capable of walking) and according to whether or not they were receiving anticonvulsants. As determined by microdensitometric analysis of radiograms of the second metacarpal bone, bone width (D), bone pattern area (sigma GS) and bone salt density (sigma GS/D) were decreased in the patients, the decreases being most prominent in group 1, followed by groups 2 and 3, in that order. Significant decreases of sigma GS and sigma GS/D, but not of D, were found in patients on anticonvulsant treatment in comparison to patients without therapy. Serum alkaline phosphatase (Al-p) and parathyroid hormone (iPTH) as well as urinary calcium and cyclic adenosine-3',5'-monophosphate (cAMP) excretion were significantly increased in group 1. In comparison to patients without therapy, anticonvulsant-treated children showed significantly decreased levels of serum calcium (Ca), ionised Ca (Ca2+), 25-hydroxy vitamin D3 and urinary phosphate (PO4) excretion, and elevated levels of Al-p, iPTH and calcitonin (iCT). It is suggested that limited physical activity results in a mild hyperparathyroid state, which is aggravated in patients on anticonvulsant treatment.

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Section: Discussionmentioning

confidence: 98%

Decreased bone density in severely handicapped children and adults, with reference to the influence of limited mobility and anticonvulsant medication

1986

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“…Im Tierversuch wurde eine verminderte Ausschüttung von Calcitonin durch Phenytoingabe beobachtet (103). Kruse et al (70,71,72) untersuchten den Calcitoninspiegel bei 40 epileptischen Kindern unter antikonvulsiver Langzeittherapie und fanden diesen signifikant niedriger als in einer entsprechenden, nicht antikonvulsiv behandelten Kontrollgruppe. Die niedrigen Calcitoninspiegel waren nach den Ergebnissen der Autoren nicht auf eine Hypokalzämie zurückzuführen, sondern auf eine direkte Wirkung der Antiepileptika.…”

Section: Verminderung Der Calcitoninsekretionunclassified

“…Häufig wird bei antikonvulsiv behandelten Patienten eine Hypokalziurie gefunden (2,5,14, 28,33,50,52,70,71,72,79,94). Aladjem et al (2) yermuten einen direkten Einfluß der Antiepileptika auf die renale Calciumresorption, unabhängig vom Parathormon.…”

Section: Erhöhte Renale Calciumresorptionunclassified

“…Bei erhöhtem Parathormonspiegel ist die Ausscheidung von Hydroxyprolin im Urin gesteigert, ein Zeichen für eine normale Wirkung des PTH auf den Kollagenumsatz (14,45,51,70,71,72). Die Beobachtungen, daß Phenytoin und Phenobarbital in vitra die durch Parathormon und 1,25(OHhD stimulierte Calciumfreisetzung an Knochen verhindere(45,109), konnte von anderen Untersuchern(70)(71)(72) in vivo nicht bestätigt werden.Spiegel bei antikonvulsiv behandelten Patienten wären als renale Antwort auf die bei Hypokalzämie vermehrte Parathormonsekretion zu erklären, die eine erhöhte Bildung von t,25(OHhD induziert (t05). Auch andere Untersucher(64,95) nehmen an, daß ein Unterschied zwischen der durch Antiepileptika verursachten Osteomalazie und der durch Vitamin-D-Mangel bedingten Osteomalazie besteht.…”

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Die Osteopathia antiepileptica bei Jugendlichen und Erwachsenen

Vahar-Matiar¹,

Fröscher²

1988

Fortschr Neurol Psychiatr

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Since Schmid (115) and Kruse (74) reported on osteopathies occurring after antiepileptic treatment in children, there have been numerous publications concerning the influence of antiepileptics on mineral metabolism in the bones. The investigators' results range from slight anomalies of the plasma levels of calcium, phosphate, alkaline phosphatase, parathormone and 25-hydroxycholecalciferol to severe bone alterations. In the majority of cases, the severe pictures occurred in retarded, neurologically abnormal, institutionalised children who were treated with a high-dose combination of several antiepileptics for epilepsy which was difficult to treat. The first case reports from adults were published by Dent et al. (26). These patients had also been treated since their early youth with an antiepileptic combination. They displayed fractures and suffered from bone pain and muscular weakness. The good response of the rachitic bone alterations to vitamin D treatment both in children and in adults indicated vitamin D deficiency. These reports prompted systematic investigations on the influence of antiepileptics on bone metabolism in numerous hospitals and outpatient departments. According to the available literature, it can be stated that antiepileptic therapy can lead to shifts in calcium and phosphate metabolism and to a raised activity of serum alkaline phosphatase. In studies comprising control groups, the patient treated with anticonvulsants more frequently displayed variations of clinical laboratory parameters. The frequent observation of vitamin D hypovitaminosis led to the assumption that alterations in vitamin D metabolism by enzyme induction are the cause of the disorders in calcium and vitamin D metabolism. This hypothesis was frequently contradicted in recent years after hypocalcaemia and alterations in the mineral content of the bone after antiepileptic therapy had been reported irrespective of the vitamin D level. Besides a restricted intestinal calcium absorption, an influence of antiepileptics on the hormones regulating calcium and phosphate metabolism was found. Thus, a multifactorial genesis of the disorders in bone mineral balance must be assumed. The fact that the vast majority of outpatients with long-term anticonvulsant therapy do not display any disorders of bone metabolism indicate that there are individually different compensation capabilities (possibly of genetic origin). According to the literature, the probability that adults will develop osteomalacia under antiepileptic therapy is associated with the joint presence of various risk factors.(ABSTRACT TRUNCATED AT 400 WORDS)

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“…Sugere-se também que as drogas ansiolíticas e anticonvulsivantes possam exercer efeito duplo sobre o metabolismo do osso e do cálcio, afetando não apenas o metabolismo da vitamina D, como também a ação do hormônio da paratireóide, indispensável para o remodelamento ósseo e para o desenvolvimento dentário. Esses efeitos dependem da dose e do tempo de uso desses medicamentos 19,38 . O objetivo do presente trabalho foi avaliar se o uso de Fenobarbital (Gardenal ® ) interfere na movimentação dentária induzida, comparando três grupos de animais (normal, controle e experimental) quanto ao aspecto clínico e radiográfico.…”

Section: Introductionunclassified

Avaliação clínica e radiográfica da influência do fenobarbital (Gardenal®) na movimentação ortodôntica: estudo em coelhos

Pithon

Ruellas

2008

Rev. Dent. Press Ortodon. Ortop. Facial

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Objetivo: Deste estudo foi avaliar clínica e radiograficamente a influência do Fenobarbital na movimentação ortodôntica. Metodologia: Foram utilizados 22 coelhos da raça Nova Zelândia (Oryctolagus cuniculus), distribuídos em três grupos: normal (N), controle (C) e experimental (E). O grupo N (n=2) não foi tratado, apenas certificada a condição de normalidade. Nos grupos C (n=10) e E (n=10), foi montado aparelho ortodôntico entre os primeiros molares e incisivos inferiores para promover a movimentação para mesial dos molares. No grupo E, foi administrado conjuntamente à movimentação dentária induzida, o medicamento Fenobarbial. Após os períodos de 7 e 14 dias os animais foram sacrificados para análise clínica e radiográfica. Conclusões: Os resultados demonstraram não haver diferenças na extensão do movimento nem alterações radiográficas entre os animais do grupo controle e experimental. ResumoPalavras-chave: Movimentação dentária. Medicamentos. Ortodontia. A r t i g o i n é d i t o INTRODUÇÃOCom relativa freqüência, observa-se grande número de pessoas que utilizam medicamentos 10 , muitos dos quais decorrentes de auto-medicação, efeito contraceptivo, tratamento de doenças crô-nicas ou uso crônico por pacientes idosos 42 . Desta forma torna-se imperioso o conhecimento do mecanismo de ação destas substâncias por parte do Cirurgião-Dentista, bem como as possíveis interações que podem ocorrer, de forma a beneficiar o tratamento ou ajustá-lo aos efeitos sobre o sistema estomatognático.O sucesso do tratamento ortodôntico depende, entre outros fatores, da remodelação óssea. A remodelação óssea bem sucedida durante o movimento dentário, apresentava vantagem de promover menor dano histológico, menor dor e movimento dentário mais rápido, resultando em menor período de tratamento 24 . O movimento dentário ortodôntico ocorre quando forças são aplicadas sobre os dentes 40 e são transmitidas ao periodonto de suporte 29 , fazendo com que modifiquem sua posição em relação às estruturas que os rodeiam 40 pelo mecanismo de remodelamento do osso alveolar 36 . Ou seja, aposição óssea na área tracionada e absorção óssea na área pressionada 14,21,26,29,36,40 . Além do conhecimento profundo sobre movi-

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Parathyroid function and serum calcitonin in children receiving anticonvulsant drugs

Cited by 12 publications

References 21 publications

Decreased bone density in severely handicapped children and adults, with reference to the influence of limited mobility and anticonvulsant medication

Decreased bone density in severely handicapped children and adults, with reference to the influence of limited mobility and anticonvulsant medication

Die Osteopathia antiepileptica bei Jugendlichen und Erwachsenen

Avaliação clínica e radiográfica da influência do fenobarbital (Gardenal®) na movimentação ortodôntica: estudo em coelhos

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